Showing posts with label homebirth. Show all posts
Showing posts with label homebirth. Show all posts

Wednesday, October 24, 2018

Breech birth at home (Fischbein & Freeze 2018)

After being under consideration for a year, our article on breech birth at home was finally published! Dr. Stuart Fischbein and I analyzed the results of 60 breech and 109 cephalic pregnancies under his care. Most took place at home and some in a freestanding birth center.


The article is free to download here: https://rdcu.be/8Zv1

We chose to pay for open-access publishing so that our article would be accessible to anyone free of charge. If you'd like to help support our work, please consider donating at our GoFundMe page.
Read more ...

Monday, June 12, 2017

A car birth, a bus birth, a yurt birth, an en caul birth, and a mother-supported birth

This reminds me of a Dr. Seuss book...
I can give birth in a car
I can give birth in a bus
in a yurt
with the caul
with my mom
A car birth
An Australian family pulls over onto the side of the road and has their baby in front of an apple shop.


A bus birth


A yurt birth
Through June 18, you can have your baby in this fully-equipped yurt in the middle of the Amsterdamse Bos. No charge to use the yurt. Sponsored by Birth Project: Look Again, which is hosting a number of activities in June. More information here.


An en caul water birth
The father lifts the caul off his daughter's face after she is born. Watch the video and read the birth story.


A mother-supported birth
A mother supports her daughter having her second home birth




Read more ...

Friday, April 22, 2016

Update on homebirth VBAC ban in Colorado

The Colorado legislature recently included a VBAC ban into pending midwifery regulations. Thanks to consumer activism, the Senate has now rescinded the VBAC ban. Here's an update from Emily Thompson:

APR 22, 2016 — Yesterday, by unanimous vote, the Senate Health Committee removed the VBAC ban amendment from HB 1360 which will continue to keep midwifery legal in Colorado. Many midwives, mothers, advocates and their supporters testified in support of both the safety and the right of mothers to choose VBAC at home.

The signatures on this petition and the many comments definitely swayed the opinions of the Senators, and the strong testimony yesterday sealed the deal.

The bill still must be heard in the full Senate, and there is the possibility of amendments being added. We're asking Colorado residents to contact their State Senator and ask them to vote YES on HB1360 as it is presented to them from the committee.

Thank you again to everyone who signed, shared, and supported this grass-roots movement!

Gratefully,
Emily

If you're wondering why preserving women's ability to have a VBAC at home is an important issue, consider this: around 50% of all US hospitals ban VBACs, either formally (hospital policy) or informally (no doctors at that hospital will attend VBACs). In those situations, a woman's only remaining choice for VBAC is an out-of-hospital birth. Banning CO midwives from attending VBACs forces those women into having unnecessary, unwanted surgeries or from having to give birth unassisted.
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Saturday, August 01, 2015

Things I'm loving right now

Only four days left  until we fly across the Atlantic! In between last-minute repairs and deep cleaning, I wanted to share some favorite things I bookmarked this past month:

Homebirths in Spain
Read about the struggle to access home births in Spain, including hurdles mothers have faced birthing outside the Spanish medical system.

Effect of skin to skin and breastfeeding on primary postpartum hemorrhage
This recent research investigates the effect of S2S and BF right after birth on reducing primary PPH rates and found a strong positive correlation. The paper is titled Does skin-to-skin contact and breastfeeding at birth affect the rate of primary postpartum haemorrhage: Results of a cohort study.

Upright birth support
A Scottish midwife designed an inflatable birth support called Comfortable Upright Birth that's being used around the world. Read about it here:



If you buy a CUB, the company donates a clean birth kit to mothers in developing countries. With every 5 birth kits, they include a CUB as well! So consider buying one for yourself if you are expecting or for your practice if you are a birth attendant.




Breech!

Home Birth
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Sunday, April 12, 2015

Goodbye, Sheila Kitzinger

I just saw the news that Sheila Kitzinger passed away today. Kitzinger's books were some of the first I read when I was first discovering midwifery and home birth. Typical of her spunky self, she was, according to her husband of 63 years, "drinking Kir Royale and champagne and eating chocolates three days ago, knowing she didn't have long."

I'm so sad to lose this wise woman. She's done an enormous service for childbearing women around the world.

Read more about Sheila here at the BBC.

Now, readers, I'd like to know...what are your favorite books by Sheila Kitzinger? (ps...her autobiography is coming out next month!)
Read more ...

Thursday, October 09, 2014

Irish midwife Philomena Canning

This week over 200 mothers, midwives, and other supporters marched to protest the suspension of Irish midwife Philomena Canning's indemnity insurance. Below is a guest post by Susannah Sweetman explaining more about the insurance issue and the status of home birth in Ireland.

Photo from Independent.ie


I am a PhD candidate in the School of Nursing and Midwifery, Trinity College Dublin. My area of research focuses on women's beliefs about birth, and examines the multiple forces that shape contemporary femininity in birth.

I am also a mother of three children, and I am 32 weeks pregnant with my fourth child. My first child was born in hospital, and my second and third children were born at home, with the support of my midwife, Philomena Canning. As of the 12th of September, the Health Service Executive has suspended Philomena's insurance, which has in effect shut down her practice, and has left 25 women without a midwife, 6 or 8 of whom, myself included, are due to give birth before Christmas.

No charges have been brought against her. The cases that are supposedly the catalyst of this suspension involve two women who were transferred to hospital following the births of their babies for precautionary reasons: all were discharged again within hours, and the mothers and babies are well. No complaint has even been made against Philomena in 31 years of practice; the women whose cases are being used against her reject any suggestion that her actions were anything less than entirely professional. Her record is exemplary: in 2012 she was awarded Midwife of the Year in Ireland, which she refused to accept on the grounds that it was sponsored by a formula company.

Only 0.2% of births in Ireland are home births, largely because there is such a lack of support at policy level. All of the international research findings around planned home birth support the view that it is associated with significantly reduced interventions, and no increased risk for perinatal outcomes. In areas where maternity care policy supports home birth provision (parts of the UK, Holland) rates are as high as 30%. The demand amongst women for home births in Ireland is evident in the over-subscription to the small number of home birth services; the continued resistance of the Health Service Executive and Department of Health and Children to support and expand these services in line with the available evidence further illustrates what a recent national report (HIQA, 2013) into the death of Savita Halappanavar described as "an inability to learn from service users' and patients' negative experiences".

There has been a series of scandals within the maternity care services in Ireland over the past number of years, including the Scans Misdiagnosis Scandal, infant deaths in Port Laoise Hospital, the Symphysiotomy Report, and a number of maternal deaths including Savita Halappanavar, Dhara Kivlehan, Bimbo Onanuga, and Tania McCabe. None of the health care providers who have been implicated in these cases have been prevented from continuing to work. On the same day that the High Court application for the reinstatement of Philomena Canning's insurance was refused, the inquest into the death of Dhara Kivlehan concluded that her death was as a result of medical misadventure.

Throughout all of these inquests and investigations into the workings of the HSE and the maternity services it has been found that the underpinning culture is one that does not support accountability, transparency, or communication. Above all, the HSE and successive Ministers for Health have displayed an utter disregard for women and babies by their continuing failure to implement evidence-based care models.

Please sign this petition, it will help to put pressure on the Minister for Health Leo Varadkar, and the HSE to reinstate Philomena's insurance and put her back in practice.

Twitter #isupportphilomenacanning

Thank you!

Susannah Sweetman

PhD Candidate
School of Nursing and Midwifery
Trinity College
Dublin 2
Read more ...

Saturday, May 10, 2014

Zari talks about cyberbullying

A conversation between me and Zari on the way home from school yesterday...

Mama, what is uploading?

Uploading is when you transfer information from your computer to the internet.

Oh. We talked about uploading and cyberbullying in school today. Do you know what that means?

Cyberbullying is when someone is mean to someone else on their computer.

Yeah, our teacher told a story about two girls who were best friends, and then they got mad at each other and they shared their passwords and they said mean things about each other. That's not right.

Did you know that sometimes adults are cyberbullies?

Really?

Yes. Did you know that there is a doctor who says mean things about me online?

Really? And she's an adult? And a doctor?

Yes.

That's not good.

She says mean things about me because she doesn't think anyone should have their babies at home. She says that mamas who have their babies at home do not love them and do not care about them.

But that's silly. You love your children!

I know.

What did you say to the doctor?

I told her she was a bully and that how she was acting wasn't right.

I'm glad that you spoke up. I think you should call the police to stop her.

No, it's the law that people can say anything they like, even if it's mean. I just choose not to pay attention to mean things that people say about me.

When I am a mama I want to have my babies at home.

Well, that will be your decision. Some women decide to have their babies at home, some decide to have them in a hospital.

Yeah, like when there's something wrong with you or the baby, then you go to a hospital.

Or sometimes women just want to be in a hospital. And that's okay.

Yes, whatever they choose is right.

I would never say mean things about a mama who wants to have her baby in a hospital. I would never say she's wrong or she doesn't care about her baby or that she's a bad mama.

Yes. If a mama had her baby in a hospital, I would say "That's great! That can be a good choice!"

Yes. I liked having my babies at home because I could have my family around me, and I could do whatever I wanted to, and nobody was bossing me around. And did you know that some mamas have their babies in a birth center?

What's a birth center?

It's a special place where you go just to have a baby, but it's not in a hospital.

Oh, that's nice.
Read more ...

Tuesday, May 06, 2014

Best Practice Guidelines: Transfer From Planned Home Birth To Hospital

I am excited to announce that the Collaboration Task Force of the Home Birth Consensus Summit drafted best practice guidelines for transferring from home or birth centers to hospital. The guidelines are free and open source, meaning you can adapt part or all to your local setting.

Having clear guidelines for both the transferring midwife/physician and for the receiving hospital staff will facilitate a respectful, seamless transfer of care. This is especially important when the mother/baby pair has transferred for an urgent or emergency situation.

The Collaboration Task Force explains how they created the guidelines:

To create the Best Practice Transfer Guidelines, the Collaboration Task Force researched existing standards for universal intrapartum transport, transfer, consultation, and collaboration guidelines for all professionals who are involved when a woman or baby is transferred to a hospital from a planned home birth, as well as the evidence on practices that lead to improved interprofessional coordination. The result is a set of guidelines designed to serve as a blueprint for all of the providers involved in a transfer, including the midwife transferring care and the receiving hospital.

The Best Practice Transfer Guidelines are open source and providers are welcome to use or adapt any part of the document as desired.

The Collaboration Task Force is accepting endorsements of the guidelines from organizations, institutions, health care providers, and other stakeholders. We are pleased to advise that the American College of Nurse-Midwives (ACNM), the Midwives Alliance of North America (MANA), and the National Association of Certified Professional Midwives (NACPM) are early endorsers.

We are asking you to show your support of respectful, collaborative care for women and families who experience transfer from a planned home birth or birth center by endorsing the guidelines and encouraging the leadership of any maternity care organization that you are affiliated with to do so also.

To obtain the guidelines and provide your endorsement, please click visit www.homebirthsummit.org/best-practice-transfer-guidelines.
Read more ...

Thursday, December 12, 2013

Post-surgery fun

I'm recovering from having my varicose veins removed yesterday. I had EVLT and ambulatory phlebectomy one one leg and sclerotherapy on the other. My legs are wrapped in layers of bandages. I have to wear them for 3 days and then I can finally take a shower. So excited for that shower tomorrow night!!! I also am curious to see the battle scars...

Anyway, I found a few things of interest:

Home Birth Dads Calendar

A fun article in the Huffington Post explains the origins of the Home Birth Dads 2014 calendar, produced by clients of InnerBirth.



New version of Home Birth: An annotated guide to the literature

This bibliography, authored by Saraswathi Vedam and colleagues, is offered as a resource for clinicians, researchers, educators and policy makers, who must, within their own context for work, assess the quality of the available evidence on planned home birth. This may be for the purpose of clinical decision making or policy development in response to the international debate on safety, access, ethics, autonomy, or resource allocation with respect to birth place.

This is an open source document.

The bibliography is updated annually and the most recent version (as well as the document saved in booklet format for printing) can always be found at the following website: http://midwifery.ubc.ca/research/research-activities/home-birth-an-annotated-guide-to-the-literature.
Read more ...

Thursday, December 05, 2013

Jim Gaffigan on home birth and life with 4 kids

This had me laughing out loud:



"We had all our babies at home, just to make you uncomfortable."

Read more ...

Wednesday, April 03, 2013

Ivy Claire's birth story

Part I: Musings

I’m sitting in a still house on a Sunday morning, my newborn curled up in a sling. As Ivy sleeps and dreams, her face flickers with smiles and frowns. She’s practicing a repertoire of expressions that she will later learn to put on purposefully. She breathes irregularly, her body not yet fully attuned to the steady rhythm of earth life.

This will be a different kind of birth story. I’ve always written detailed play-by-play versions: this happened, and then this, and then this. It was my strategy for capturing as much as possible before the smallest things sifted away through the cracks in my memory.

But the problem with writing a story down is that what gets left out no longer can exist. It disappears from the page and eventually from memory. If I write that labor was calm and empowering, or difficult and fierce, or any other combination of words, then it becomes hemmed in by what it was not. By what I did not say or remember.

I could choose a list of words to describe the day I gave birth. All are true, yet they contradict each other and still do not approach the essence of that day. If I swim in a river for a few hours, I cannot return the next day and recapture the water I swam in. It is gone forever. Even if I document the moment in a photograph or video, those images cannot reproduce the pressure of the water or the pull of the currents or the way the thousands of tiny hairs on my body swirled in response.

And yet, I must try: I remember calm and peace. Quiet accentuated by the muffled thumps of my children playing in the attic. The clatter of pans and dishes in the kitchen, cupboard doors closing. Ferocity and fear and uncertainty. The peculiar stillness that follows a snowstorm. Wildness and chaos contained by the pattern of my body’s labor. Hope for a living, healthy child and the audacity of that desire. Disbelief that it would actually happen. Uncertainty about the process gripping my body, alongside an uncanny awareness--sometimes demonstrated only in hindsight--of what was happening.

During this pregnancy I swam in (against?) an undercurrent of fear. It didn’t dominate my pregnancy, but it was always there pressing against my body, reminding me that I could not blissfully talk about the baby inside me as if it were already safely born. It was a hint of bitterness in everything I touched, if only the smallest aftertaste. With each pregnancy, I become more acutely aware of how much I stand to lose. Amidst all the other reasons for being done having children, the biggest is this feeling of tempting--and cheating--fate. I have four beautiful, healthy children and for that I feel incredibly blessed. Lucky, even. Isn’t it best to stop while I am ahead? I often think.

I could not let myself fully believe or imagine this new child until it was safely here earthside. No matter that suspended belief would not alter the outcome in any way. Until I saw and heard the baby, nothing was fixed or certain. That is why I exclaimed, as soon as Ivy emerged, “I can’t believe I have a baby!”

Part II: A series of vignettes

The night before the birth. We eat dinner at a friend’s house, and I hide the strong but intermittent contractions. This is not labor yet: no pattern, no rush of hormones. But I know it was the beginning. It is my secret. Later that evening I feel shaky, anxious. I am brought back to my university days--those hours before you take a big exam, when you’ve prepared as much as you can and all you can do is worry and wait until the work begins. Multiply that anticipation and tension a hundredfold, and that is what I am feeling. I know that labor will begin at night with strong but irregular contractions. That I will sleep in between them for at least part of the night. That I will stay in bed until morning, listening to my hypnosis tracks if I am unable to sleep. That I will finally get up, knowing active labor will begin but ready to work with contractions after a night of lying through them.

Morning, 6:30 am. In bed, contractions are increasingly strong but still widely spaced. I do not watch the clock until right before I get out of bed. They are 10-12 minutes apart.

I get up and feel palpable anxiety within my body. I know what is coming. I know what I have to go through to get the baby out...and it weighs on me. I feel shaky, uneasy, and unsure.

I ask Eric for a blessing. Some things are too personal to share, but I feel the power of the message moving through Eric. At this moment he is just a voice for something more vast and wise than himself. He assures me that I will birth smoothly and without complications, that this birth will bring the same joy that my other children’s births did. I finally feel able to move forward toward the task at hand.

As soon as I am up, contractions come quickly. They also seem a bit shorter, but it might be because I’m moving rather than lying still. The few times I glance at the clock, they are around 4 minutes apart.

We had a massive blizzard the night before, and the roads are terrible. I tell the midwife and the photographer to come right away based on the following calculation:
Time from getting up to move with the contractions until birth:
Zari: 10 hours
Dio: 7 ½ hours
Inga: 2 ½ hours
This baby: ??? but I know it will not be long

Around 8:30 am. The household is awake. Children are eating breakfast. Eric is fulfilling a list of tasks (fill the pool, dress the children, call the babysitter, gather some final supplies). I’m leaning over the radiator next to the bedroom window, feeling the heat shimmer up my arms and chest. Outside is deep in untracked snow. Our babysitter pulls into the driveway and her car gets stuck. The midwife’s car has just turned onto the street. A man arrives with a snowblower, clears out the pile of plowed snow blocking our driveway and our entire front sidewalk. A small serendipity. I speak on the phone to the photographer, who arrives soon after and tries to enter the wrong house at first, 3 doors down. The snow has altered the landscape. It makes the day seem separate from reality, a small window away from the mundane.

Around 9:30 am. The birth pool is filled, yet I resist entering. For so many laboring women, the water promises instant relief. But for me, water can feel like a prison as much as an escape. I have to be upright moving my hips during contractions. I labored in and out of the tub when I had Zari, but never wanted to stay in for more than 30 minutes at a time. For my next two, I didn’t get in until pushing was imminent. So here I am, eying the tub, wanting the warmth and buoyancy of the water but dreading the restriction it might bring.

I’m also feeling tired and extremely dizzy. I never experience the pleasant, heady rush of endorphins I’d had during my three other labors. Instead, it manifests only as dizziness.

Around 10 am. I want to know what’s going on with my cervix. I’d reached in multiple times over the past several hours, but labor has turned all the familiar landmarks into mush. All I know for sure is that the head is fairly low. I catch myself thinking, “Does asking for an exam mean I don’t trust the process? Will it mess me up mentally by having a number associated with my sensations?” And then I realize: Who cares. I want to know, and that’s reason enough.

So I tell the midwife laughingly: “I’m asking you for the first vaginal exam ever in four pregnancies and labors!” She looks surprised and wants to know if I am sure. “Yes, and I know it has absolutely no significance on how long it will take from here on. But I really want to compare it against what I am feeling going on in my body.”

I am a very stretchy 5 cms and the head is quite low, past the ischial spines. This confirms all that I had been feeling and seeing so far. I am not delusional. The bloody show is telling the truth, that persistent rectal pressure wasn’t a figment of my imagination, and labor is well on its way.

I get in the tub and find that I can still move my hips the right way if I kneel and lean over the edge. Only my legs and lower belly are immersed, so I add lots of hot water. It feels delicious. I keep trying to sleep but I can’t rest my head properly.

A few minutes later. In between my efforts to sleep, I pop my head up and say to the midwife, “I really need to work on the CEU & CME applications for the breech workshop in June.”

Around 10:20 am. I know I’m going to start pushing. Not right away, but in 4-5 more contractions. It’s the subtlest catch in my throat, so quiet no one else can hear. It’s the slightest downward heaving during a contraction. I keep this knowledge a secret for a few more contractions. One nice thing about being a seasoned multip is that you can read your body’s cues with extreme accuracy.

Part III: Pushing

I really dislike pushing. I fear it, I dread it, and when it actually begins I endure it only because I have to. I try to convince myself that I should be excited because pushing means the baby will be born soon. But no, it still is just as unpleasant each time. I don’t doubt those women who look forward to pushing and find that it takes the pain of transition away--it’s just never happened that way to me.

There was something “off” about this pushing stage. It took too long at first and then went too quickly at the end. Once you’ve pushed several babies out of your vagina, you know when something is abnormal. When I first checked, the baby’s head was just two knuckles deep. But after several really strong contractions--violently strong--I reached inside and the baby’s head was significantly higher up. I felt a stretchy band of something, probably a lip of anterior cervix, about 1 cm at the widest point and as thick as my eyelid. It stayed through several more contractions. We guessed it was a cervical lip acting, in my midwife’s words, like a “slingshot” and pulling the baby back in. Between contractions I’d stretch it and try to slip it under the pubic bone, but there wasn’t quite enough space for my fingers to push it back.

My body was pushing ferociously, made so much worse by the unexplained resistance keeping the baby’s head from descending. You won’t see any gentle “breathing the baby down” in the birth video. I had absolutely no control over what was happening during contractions.

During one of the pauses, I reached inside and felt a small bubble of water bag. It burst with a small pinch. “I just broke the water bag,” I announced. Maybe this would help bring the baby down?

Nothing happened after the next two contractions, but the earth shifted during the following one. In what I call The Mother Of All Contractions, my body gave a tremendous, 5-minute-long push that brought the baby all the way down, to crowning, and out with only the tiniest pauses.

This was just as un-fun as pushing with no progress. I was sure I’d tear. (I didn't. My body rocks.) Nothing had time to stretch or mold. I barely had time to apply counter-pressure and to cup the baby’s head in my hand before it slid out. The shoulders came just a second or two later. I didn’t even have time to look down before she was all the way out.

The first thing I remember seeing was Ivy’s hand reaching up. I lifted her out of the water, unwound a nuchal cord, and put her to my chest in one fluid motion. When I watch the birth video, I am amazed at the complex series of movements that I performed without conscious effort. I don’t remember thinking about having to shift her to the other hand and unwrap the cord; I just did it.

Part IV: Feel the Fear

Two days after I gave birth, I read these words from a British midwife currently practicing in Australia:
In a backlash against the medicalisation of birth women are beginning to reclaim birth (yay!). Partly thanks to the availability of information via the internet, a counter culture has emerged. Movies, images and stories of empowered birthing mothers circulate through social media – women birthing in beautiful calm environments (usually in water, surrounded by candles), looking like Goddesses whilst gently and quietly ‘breathing’ their baby out. Women are able to see how birth can be, and many are inspired and driven to create a birth experience like those they watch.

Whilst these images can assist in building self-trust for mothers as they approach birth, they do not tell the whole story....

Regardless of attempts to ensure safety, deep down, like our ancestors we know we step into the unknown during birth. Fear is a normal part of birth....

Women who manage to remain calm and serene whilst birthing are admired for maintaining control. In contrast, those who are loud, and appear to ‘lose it’ are considered to be out of control....We have created a culture (and birth culture) that seeks to avoid and minimise extreme emotion and pain, and encourages being in control.... I think it is a shame that this powerful aspect of the birth experience remains hidden and suppressed.
I am telling my story first, before sharing the video or the pictures, so you know my internal experience before viewing it from an observer’s perspective. This birth was really hard. When I edited the video, I purposefully kept the most intense parts. Most of what I removed were the long periods of silence and rest--not because they don’t have value, but because if the video is too long, people won’t end up watching it!

I’m going to share the pictures last because I know they will be transcendent and amazing. If I have any complaint about birth photography, it’s that it can capture beauty in the most desperate, difficult moments. I don’t want my birth story to only show a calm, beautiful “birthing Goddess” or a triumphant superheroine or a rockstar or a woman silently relaxing through her “pressure waves.” I want it to also show the agony and the difficulty that make those previous images possible. Birth isn’t about avoiding one set of realities in favor of another. It’s about embracing all facets of birth--contradictory, messy, or unpleasant as some might be--as vital to the whole.

Ivy's birth video here.

Ivy's birth photos here

Read more ...

Tuesday, January 22, 2013

Homebirth legislation in Slovakia

I recently received this update from Iva Jancigova, who helped me translate some articles about home birth legislation from Czech to English:

This time it's about my own country--Slovakia. At the end of December, the Minister of Interior Robert Kaliňák introduced some law changes to the Law of Registration Offices (I don't know the proper English translation...these are the offices that issue birth certificates, marriage certificates and death certificates). The new law says that if a birth occurred out of hospital, the baby can only be registered at this office (and have a birth certificate issued) after the mother has a gynecological exam by a doctor. Until now, parents only had to show their IDs and announce the birth at the Registration Office. There are no "official" homebirth midwives in Slovakia, but some women still choose homebirth either with an underground midwife or without one. If these changes in law are approved, they will complicate the matters significantly for women who want to avoid obgyns and/or birth at home without the need to go anywhere. I'm not even starting on the violation of privacy, because then this e-mail would get really angry.

Two nonprofit organizations (one of them is the Women's Circles I already wrote you about) wrote an open objection and collected enough signatures that it has to be heard. See http://www.zenskekruhy.sk/nase-aktivity/napisali-sme/item/195-podporte-pravo-zien-zvolit-si-okolnosti-porodu. Now we're waiting to see how the negotiations will go. I really hope that the changes won't go through.

Iva Jancigova
Read more ...

Thursday, November 15, 2012

Breech Birth at Home: Heads Up! Breech Conference

Day 2
Breech Birth At Home:
Considerations, Safety, and Informed Choice

Panelists

  • Mary Cooper
  • Diane Goslin
  • Stuart Fischbein
  • Jane Evans
  • Moderator: Ina May Gaskin

Mary Cooper mostly works with 5 Plain communities: 3 Amish and 2 Mennonite. She also serves “English” moms. It’s very important to share with clients what a breech birth means. They also need to read up more about it on their own. She demonstrates breech births to her clients with a doll & pelvis. Because of her client population, most of her moms think breech is simply a variation of normal. There’s also less fear associated with breech among her clients. She has a few supportive doctors who will do VBB if the mom is a multip.

She tells her moms that the labor will be different than a head-down baby and that she will sit on her hands and not do anything until the very end. She might ask them to take a different birthing position if something is not going well, otherwise they choose the positions they prefer.

She has a very good relationship with a local physician and hospital, so when she transports, they have everything ready for her. You have to listen to your moms. There might be residual fears left over from previous births, so don’t be surprised by emotional ups and downs during labors. Carefully observe the mother and baby and use your own skills.

She’s done 59 breeches and transported 3 of those.

Diane Goslin has helped over 6,000 babies come into the world. She works in Lancaster, PA. She serves both Plain (50-60%) and English communities. She has always offered VBB because her community also considers breech a variation of normal. Hospital birth is largely not an option for most of her clients due to finances and lack of health insurance. Many also plan very large families, so CS is not an option. She has become more comfortable watching the process unfold and has become more hands-off over the years.

She has a higher anomaly rate among her Plain communities (because they do not seek prenatal ultrasounds generally) and a resultant higher rate of breech babies. During prenatal visits, she explains the mechanics of breech and goes through the birth process with a doll & pelvis. Over 30 years, she’s transported two vaginal breeches, both at the mother’s choice. One was for an elective cesarean, the other for a transverse second twin.

If we start a breech, we finish it unless complications arise. They’ve had a good number of incomplete & footling breeches. They get many primip breech referrals. They follow the mother as she moves and chooses different positions.

Most of her moms consider breech a variation of normal; they’ve watched animals give birth and are comfortable with the mammalian birth process. The key advantage of birthing at home to her mothers is they’re not bringing fear into the birth environment. They supporting and encouraging their mothers. She occasionally dismisses students who bring too much fear into the room.

We need to be able to recognize when intervention is necessary and what to do. It’s good to work with other midwives to share knowledge and experience. She asks midwives to come along with their referral clients.

When she started attending births in the late 1970s, she went to a birth solo and the woman's baby was presenting breech. She applied what she’d learned about ECV and turned the baby. She put on the husband’s back support belt in place to keep the baby positioned. That was her first breech experience. She’s done many external versions at home with careful monitoring & listening.

Because most of her clientele considered home the natural place to give birth, they had to facilitate a lot of their desires for VBB. And because so many of them would have large families, she didn’t want to “wreck their career” by starting off with a cesarean. They also had the time to progress at their own rate. They found many primips would take a long time to come down. As long as the mom had energy and baby was doing well, they saw no reason to hurry the process.

Her clientele’s babies start out at 3500-4000g or above; she has a Germanic population with large pelvises and large babies and they’ve had good outcomes all around, breech or head-down.

The inherent risks of breech are inexperience and fear. Her job as a mentor and preceptor is to give other midwives as much exposure & experience as possible in an environment free of fear. Would most of her clientele choose a hospital birth if it offered VBB? Not the Plain population, but many of her English referrals coming in from out of town would definitely go for vaginal breech birth in a supportive, relaxed hospital environment.

Stuart Fischbein is a referral source for practitioners in the LA area; most of his breech clients he doesn’t meet until late in pregnancy. His initial visit is 1 ½ hours; subsequent prenatal visits are 1 hour. He works under more of a time crunch with his breech referrals. At a time when there should be peace & calm in a woman's pregnancy, there’s lots of turmoil. He reviews their history and if they fit the criteria, he reassures them that there’s a good chance of success. Breech labors progress or fail for the same reasons that head-down labors progress or fail.

He gives his clients evidence-based articles to read, discusses the TBT, and explains why most area doctors do not support VBB. Of his 7 criteria, the most important one is having the “right mental stuff”
  • EFW 2500-4000g
  • Flexed head
  • Frank or complete
  • no major fetal anomalies (uterine anomalies are not a contraindication, although he keeps an eye out for increased risk of retained placenta)
  • wait for labor to begin
  • baby has to tolerate labor
  • woman has the right mental stuff

Why is he doing home births? He never would have thought that he’d be doing this. When he finished residency at Cedars Sinai in 1986, it was the busiest hospital in country with 22,000 births/year. They saw everything: breeches, forceps, class IV heart disease, etc. He came out of there with really good training. After he was done, midwives approached him to be a backup physician, and he agreed. For 10 years, he backed midwives and then started a collaborative practice with CNMs in Ventura County. After about 15 years there, the environment became very hostile. Both the pediatricians and anesthesiologists gave his practice a hard time because his patients didn’t want Vit K, bottle feeding, mother-baby separation, early cord clamping, etc. Eventually the midwives were banned from attending births at the hospital for a year. Then the hospital forbid him from doing VBACs and breeches. He could have hired a lawyer and tried to fight the administrative process, which is a losing proposition and costs a fortune. At the same time, he was asked by midwives if he’d be interested in doing home births. He thought for about a “nanosecond” and then said yes. He was fortunate to have that option, and he’s never looked back. He doesn’t miss the craziness and micromanagement of the hospital environment.

There is a place for home birth. He hopes that physicians will consider this as an option down the road. His eventual goal is to build a regional center for breech deliveries. But for now he can offer people a choice in a home setting, although finances can be a challenge.

He’s very quick to tell people if they’re not a good candidate. He’s not trying to be a hero; safety is the utmost issue.

Jane Evans worked with the NHS for 20 years before becoming an independent midwife (IM). The NHS became more and more restrictive and compromised the care she was able to offer women. IMs are still scrutinized and judged for their profession.

She spends a lot of time talking through the options, the risks, and the parameters of safety. It all comes down to informed decision-making. The woman has to make the decision for that baby, that pregnancy, for her family and for herself.
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Monday, November 05, 2012

Any Czech speakers out there? (updated)

I need help translating a few articles from Czech into English. They discuss recent Czech petitions to the European Court of Human Rights regarding home birth. I've run them through Google Translate and it gave me a very rough translation--enough to get the gist but not much else. Can anyone help?

Here are the articles:
  • (Most important) http://www.tyden.cz/rubriky/domaci/budouci-matky-a-porodni-asistentky-zazaluji-cesko_222281.html
  • http://www.tyden.cz/rubriky/domaci/zdravotnictvi/soudce-zadostem-o-asistentku-pro-domaci-porod-nelze-vyhovet_234030.html
  • http://www.tyden.cz/rubriky/domaci/zdravotnictvi/zakazane-porodni-asistentky-radi-zenam-aspon-po-telefonu_246301.html 
  • http://www.tyden.cz/rubriky/domaci/zdravotnictvi/zeny-budou-rodit-doma-bez-dozoru-desi-se-asistentky_229532.html
  • http://www.tyden.cz/rubriky/domaci/zdravotnictvi/liga-lidskych-prav-chce-u-soudu-prosadit-narok-zen-na-porod-doma_234907.html
The best Google Translate parts:
For example any cesarean should be feasible within 15 minutes. And to do this is by midwives needed including incubator, the delivery room and anesthesia machine. In addition, perform the "Emperor" can only doctor. 
What if we started referring to a cesarean section as an "Emperor"?

We'd have the Unneccesemperor...Vaginal Births After Emperor...Elective Emperors...Court-Ordered Emperors. Quite the ring.

This one really made me laugh:
Farrowing houses as a possible compromise
Now we can stop having vaginal births after Emperors in birth centers and start having them in farrowing houses! 

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Wednesday, September 19, 2012

Cochrane Review: "all countries should consider establishing home birth services"

A new Cochrane review of home birth has concluded that that "that all countries should consider establishing home birth services with collaborative medical back up and offer low-risk pregnant women information about the available evidence and the possible choices."

Besides examining the evidence, the reviewers also address the interplay of autonomy and concern for fetal rights. Having recently participated in similar discussions at the Human Rights in Childbirth Conference, I was excited to see the following commentary:
This review shows that there is no strong evidence to favour either planned hospital or planned home birth for selected, low risk pregnant women. From an autonomy-based ethical perspective the only justification for practices that restrict a woman’s autonomy and her freedom of choice, would be clear evidence that these restrictive practices do more good than harm (Enkin 1995), as we stated in the previous version of this review (Olsen 1998). A decade later, the European Court of Human Rights in Strasbourg handed down a judgment stating that “the right to respect for private life includes the right to choose the circumstances of birth”. Thus, no matter what the level of evidence is, European governments are not allowed to impose, e.g. “fines on midwives assisting at home births” as it “constitutes an interference in the exercise of the rights ... of pregnant mothers” (Registrar 2010). On the other hand, the ethical concept of the fetus as a patient (Chervenak 1992) may lead some to state that “Obstetricians have an ethical obligation to disclose the increased risks of perinatal and neonatal mortality and morbidity from planned home birth in the context of American healthcare and should recommend against it” (Chervenak 2011) and that “In clinical practice it involves recommending … aggressive management (interventions such as fetal surveillance, tocolysis, Caesarean delivery)” (Chervenak 1992). In this ethical perspective recommendations about interventions are acceptable even when they are not supported by randomised controlled trial (RCT) data. The lack of strong evidence from RCTs and an autonomy-based ethical perspective lead to the conclusion that all countries should consider establishing home birth services with collaborative medical back up and offer low-risk pregnant women information about the available evidence and the possible choices.
One of the limitations of a Cochrane Review of home birth is the very small number of RCTs on home birth. I highly recommend reading the chapter on home birth in Amy Romano and Henci Goer's new book Optimal Care in Childbirth. They examine a large number of high-quality studies that the Cochrane Review does not include. (My review of this book is forthcoming.)

The updated Cochrane Review is significant for those working to reform American maternity care policies. Notice the language supporting autonomy, accurate information, integrated home birth services, and professional collaboration from last year's Home Birth Consensus Summit. The new Cochrane recommendations should make it easier to translate these consensus statements into action:
  • We uphold the autonomy of all childbearing women....Shared decision making includes mutual sharing of information about benefits and harms of the range of care options, respect for the woman’s autonomy to make decisions in accordance with her values and preferences, and freedom from coercion or punishment for her choices. (Statement 1)
  • We believe that collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits. (Statement 2)
  • Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings. (from Statement 6)

For more information on the Cochrane Review on home birth:

Read more ...

Thursday, June 07, 2012

Homebirth in Australia: more marginalized and less safe

Homebirth Australia just issued a statement responding to the SA Deputy Coroner's recommendations to require health care workers to reported planned "high-risk" home births (more details available at the end of this post). The statement is included in full below.

Also worth reading is Hannah Dahlen's article Pushing home birth underground raises safety concerns. Dahlen is an associate professor of midwifery at University of Western Sydney.

~~~~~

Coroner’s Recommendations:  
Short sighted and misses the point on homebirth
7 June 2012

Following an inquest in to the death of three babies, recommendations about the provision of homebirth services have been made by South Australian Deputy Coroner Anthony Schapel.

Homebirth Australia has concerns about the recommendations made by the Coroner. It is our view that, if implemented, the recommendations will lead to homebirth becoming more marginalised and less safe.

What was missing from the Coroner’s findings was any real consideration of the reasons why women choose homebirth. Lack of access to quality maternity care options and sensitive providers forces many women to turn their back on hospital care.

Listening to women, respecting their autonomy and developing services that genuinely meet their needs we will do far more to ensure the safety of mothers and babies than punitive short-sighted responses that remove options and marginalise certain choices.

Women make the choice to give birth outside a hospital with identified risk factors due to their profound dissatisfaction with the current maternity care system and in some cases because of previous hospital experiences that have left them deeply traumatised.

When our hospitals leave women so damaged after a birth that they refuse to return no matter what the risk, then we need to look at why.

Any law reform around homebirth must recognise that all women (including pregnant women) have a fundamental right to bodily autonomy and a legal right to refuse medical care.

The right of women to make decisions around the circumstances of their births and to choose homebirth has been recognised by the European Court of Human Rights.

The ability of women to make decisions about their maternity care is recognised at common law and by the Australian College of Midwives, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the Australian Medical Association.

Women will continue to choose homebirth regardless of the legal or regulatory framework surrounding midwifery practice and other women will heed their call for support if the maternity care system fails to support them to give birth at home.

Contact: Michelle Meares – 0439 645 372

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Friday, April 20, 2012

Home birth regulations around the world

Midwives across the United States face arrest or imprisonment if they practice in a state that does not recognize their certification, such as this Indiana CPM Ireena Keeslar who was arrested and released on $10,000 bail. Keeslar serves a large Amish population in her county and, ironically, can practice legally just over the border in Michigan.

In Ontario, Canada, midwives and consumers have been calling for birth centers; currently the province's midwives can only attend home or hospitals births. The neighboring province of Quebec has a long, successful history of birth centers with 11 currently in operation. But since Ontario began regulating midwifery in 1994, it has only offered women the choice of home or hospital birth. Just a few weeks ago, Premier Dalton McGuinty announced a $6 million pilot program of 2 birth centers in Ontario. The locations are yet to be determined; one will likely be in Toronto.

If you thought having a home birth was difficult in Canada (where in some provinces you have to book a midwife the minute you take a pregnancy test) or in the US (where midwives practice "under the table" in several states), Israel is taking home birth regulations to a new level. Last December, the Israel health ministry drafted new rules regulating home birth. Some of the proposed restrictions include:
  • The mother must obtain a "letter from her family doctor testifying that she is both physically and mentally sound"
  • The home can be no more than 30 minutes from the hospital
  • The room where the birth will take place must be at least 10 square meters (108 sq ft)
  • Birth attendants must recertify in neonatal resuscitation every year, rather than every 2 years
  • Maternal temperature cannot go above 37.8 degrees Celsius
  • Active labor must begin within 6 hours of the water breaking
  • The placenta must be born within an hour
  • The attendant must return to reexamine with woman 24 hours after the birth
The proposed regulations are a round-about way of further restricting, if not stopping, home birth. A few of these (more frequent NNR certification, 24-hour postpartum visit) may be reasonable, but most place onerous burdens upon woman seeking home births. After public criticism of these guidelines, the Israel health ministry delayed their implementation and organized meetings with stakeholder groups, including home birth midwives.

In the UK, the BBC series Call the Midwife, about midwifery in 1950s London, has sparked renewed interest in caseload community midwifery. Annie Francis, programme director of Neighborhood Midwives, describes what caseload midwifery looks like:
Once they've booked with us, we'll guarantee that they'll be seen by a midwife they know, whether it's in their home or in a clinic, every single time they need to see a professional during their pregnancy, birth and afterwards. If their needs change and they need to see an obstetrician, we'll go with them. If they end up needing a caesarean section, we'll still be there by their side.

We're expecting that between 80 and 90% of our clients will give birth at home – and that's compared with a national home birth rate of around 2% [in England], although studies show that many more women would like home births than are currently given the chance to have one.

In the Czech Republic, the Prague Municipal Court ruled that hospitals must provide home birth services to women who desire them. "[R]eferring to a recent ruling of the European Court of Human Rights in a similar case in Hungary, the judge said women indeed have the right to choose the place where they give birth to their children. The court also said that the woman was entitled to all necessary assistance from the hospital because the state had so far denied the registration of private midwives who would otherwise do the job." More articles on the topic here and here and here.

In Australia, Professor Euan Wallace, director of obstetrics at Southern Health, has called for more publicly funded home birth programs.

A South Asian study found that using delivery kits and associated clean delivery practices improved infant survival for babies born at home in "rural areas with limited access to healthcare." The kits include soap, a sterilized blade for cutting the cord, clean string for tying the cord, and a plastic sheet.

Finally, in Liberia, President Ellen Johnson Sirleaf "has given a strict mandate that no woman should give birth at home, as has traditionally been the case." Health officers commented that in order to make the mandate effective, the country must build more maternity centers, especially in remote areas.
Read more ...

Tuesday, April 03, 2012

Don't punish mothers

I just finished reading The Scalpel and the Silver Bear, the story of the first Navajo woman surgeon. In her book, Lori Alvord describes how she integrated her Navajo spiritual beliefs into her surgical practice. One incident really challenged her determination to treat all her patients with respect, dignity, and cultural sensitivity: A young girl came into her hospital in extreme pain. Every symptom pointed to acute appendicitis. But the girl's grandmother, the key decision-maker in the family and in Navajo culture, refused. Dr. Alvord describes her feelings at that moment:
I could see both sides of the story. One side--the trained medical practitioner, who fathoms the body's mysteries as a detective directs a beam of light into a dark room to look for clues about the source of physical disharmony--said, Roll her into the OR now! But the Navajo part of me, who had once been a little girl, could see the inappropriateness of interfering. Navajo eyes warned: The beauty of the body would be disturbed. A surgical knife would defile an intact, miniature universe, with rules and systems that evolved naturally over millennia. I could see the sacredness of that body, how all its many parts are one harmonic system.
She knew that this grandmother's fear of white, western medicine went back to the grandmother's firsthand experience witnessing Navajo children being forced into white boarding schools, back (only a few decades) to when the Bill of Rights and religious freedom did not apply to Native Americans, back even farther into the strong cultural memory of the Long Walk of 1863 that displaced and killed thousands of Navajos.

While Dr. Alvord was trying to find a way to meet this grandmother on her own ground and persuade--but not force--her to consent to the girl's surgery, the pressure was rising. Hospital social workers were seeking a legal court order to override the family's opposition. Even though this would save the girl's life, Dr. Alvord wanted to find a way to preserve the family's dignity and autonomy. She decided to give the grandmother control. "I told Bernice that the decision was hers to make. It was something I had begun to tell patients more and more, a show of respect that I believed would be empowering; that they alone, not the doctors or anyone else, control the fate of their bodies," she writes. More relatives arrives, more time passed, and the court order was closer to completion. "Although the court order might save the girl's life, it could also be a cultural disaster, and it would make a liar and an enemy of me."

At the end of the day--the girl still sick, the hospital staff in suspense, the grandmother still unrelenting--Dr. Alvord had a quiet conversation with the girl's father, letting him know that the decision was still his, but that it needed to be made soon before it was too late. Soon after, word came via her pager that the consent forms were signed. She rushed in and removed the infected appendix.

This small drama illuminates a larger truth about meeting patients on their terms, not the provider's or the hospital's. Women who wish to give birth outside the norm--whether an unmedicated hospital birth with intermittent monitoring and no IV access, a planned home birth, or a vaginal breech birth--often face ridicule, hostility, and threats of punishment. These tensions are particularly strong during hospital transfers or when a woman actively disagrees with her care provider about her plan of care.

Earlier this year, Australian Medical Association WA president proposed criminal penalties for mothers who have high-risk home births. "We're talking about when people choose to proceed with a homebirth when it's clear that there is an extreme danger to the baby and particularly when that's encouraged by people who should know better," Dr. Dave Mountain said. Michelle Mears, spokeswoman for Homebirth Australia, remarked, "To suggest that traumatised women who are refugees from obstetric medical care and their care providers should be charged with a crime is a proposal to move back to the dark ages." In February, the Attorney General struck down that proposal, so homebirth related deaths will not be part of the proposed fetal homicide laws in WA. But this will not erase tensions over women's childbirth choices.

I understand why some hospital staff might struggle to understand women's desire for a home birth (or a vaginal breech birth, or even an unmedicated birth). But this doesn't negate the very real fears, desires, and values that women bring to their births. Punishing women for insisting that their own values and wishes are important is the wrong approach. It will only further the divide between home and hospital advocates and push home birth women and midwives deeper underground, deeper into riskier territories. Meeting women where they stand, respecting their values and beliefs, and always upholding their autonomy--these actions are what are when obstetric conflict arises. Not punishment or threats.

A surgeon will see a necessary appendectomy as a no-brainer: Do the surgery and live. Don't do it and die. Likewise, for some people, a cesarean section is a minor event and causes little heartache. It might even be seen as preferable to a "bloody, messy" vaginal birth. But to others, a cesarean section means a devastating loss of bodily integrity, weeks or months of debilitating pain, and a feeling of failure or incompleteness as a mother. The solution isn't to legislate one of these worldviews and ban the other. The solution is to respect patients' wishes and values, to treat them with dignity, and to uphold their autonomy. When Dr. Alvord did this with the little girl and her family, she acted as a true healer, not just as a physician.
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Thursday, March 01, 2012

Birth Around the World: Dr. Beatrice Tucker and Chicago Maternity Center

I just came across a must-read article about Dr. Beatrice Tucker and her work with the Chicago Maternity Center, which provided prenatal care and home birth to Chicago's working class for over four decadies (1932-1973). Dr. Tucker trained with Dr. Joseph DeLee (infamous for his "giving birth is like falling on a pitchfork" analogy). I admire her tireless work to provide safe, humane care for people who weren't usually seen as worthy of consideration. I love how she kept meticulous records and analyzed every poor outcome to find ways to improve her care.

A few excerpts to whet your appetite:
The Chicago Maternity Center was not located on the grounds of a prestigious medical school like Harvard, Johns Hopkins or University of Chicago. It was not a wing of a world famous hospital or a clinic like Mayo, the Cleveland Clinic or Mt. Sinai. Instead the Maternity Center was located at 1336 South Newberry Street in the heart of Chicago’s West Side. When Dr. Beatrice Tucker became the Maternity Center director in 1932, West Side Chicago was a desperately poor immigrant working class community.

The diseases of urban poverty like tuberculosis, anemia, rickets, & syphilis stalked the lives of the residents. Housing was miserably hot in the summer and icy cold in the winter. There was unemployment, labor exploitation, malnutrition, street violence and domestic abuse. All of this combined into a perfect storm of mental and physical stress to further weaken human immune systems. Yet the dogged physicians, interns and nurses of the Center who went into these homes to deliver babies had better success rates than some of the finest private hospitals. Tucker respected the competent midwives and doctors that she met in the course of her work in the Chicago slums, but was contemptuous of those who did not share her passion for constant improvement. All patients deserved only the best....

Tucker and Benaron set an example of calm compassionate caring for their Center medical workers. Their patients were human beings and deserved to be treated as such. The pseudo-science of eugenics was popular among the moneyed elite before the Nazi Holocaust made those ideas unpopular. Eugenicists questioned why any money or resources should be directed to the "subhuman" population who lived in the urban slums of cities like Chicago.The Center had no use for those ugly racist, class biased ideas. All patients deserved respect and all life was sacred. Period....

Today a gleaming ultra-modern medical complex overlooks the Eisenhower Expressway not far from where the Chicago Maternity Center dispatched its medical workers. The Illinois Medical District is the largest medical center in the USA. Its gleaming towers are a testament to corporate medicine in all of its glory. You can take the Pink Line of the CTA from downtown Chicago and be there in a few minutes.

Just a short distance away from the Illinois Medical District are Chicago neighborhoods where the maternal and infant death rates are worse than in some 3rd World countries. There seems to be a historical amnesia about the medical advances that the Chicago Maternity Center made in its Fight for Life. Corporate profit has triumphed over the deeply personal and highly effective medical procedures practiced and taught by Dr. Tucker.

The original article has several photos and videos. Read the rest here--it's worth your time.
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Monday, February 06, 2012

Birth Around The World: 1950s London

The Telegraph's Anna Tyzach interviewed Monica Fitten about her midwifery training in 1950s London. Below are excerpts from her interview. You can read the complete version here.

In 1955, when I was a young nurse working in London, . . . nurses were expected to be able to deliver a child. And if you didn’t know your midwifery, you were considered no better than a lay person when it came to attending a woman in labour. It was a steep learning curve with little time off but within six months, I’d delivered more babies than I can count, and had become an authority on the subject of child-bearing women – and their husbands.

Birth wasn’t a medical event back then; it was a family occasion conducted on the marital bed. Only women expecting twins or triplets or experiencing complications such as toxaemia ended up in hospital; everyone else just got on with it at home.

I’d spend my days cycling between mothers-to-be in Hammersmith, my allocated district, making sure their homes were suitable for a birth. Most women – or should I say their mothers – would have cleaned the bedroom, but running water and indoor sanitation were still a luxury in those days; many people had outside loos or shared a bathroom with several other flats, which would make my job tricky. In extreme cases – when the surroundings were truly filthy, for example, or if we knew the father was physically abusing the mother – we would send the woman off to the maternity unit to have her baby in clean sheets and peace and quiet.

I never made any attempts to glamorise birth or play down the upheaval a new baby would bring. It was no use euphemistically saying “it’s all in the mind”; I’d warn the expectant mother that it was going to be damned painful. It didn’t always sink in, though. I got used to women kicking up a fuss as they went into the second stage of labour. It’s just human nature. Some of us – myself included – are born with low pain thresholds while others give birth almost effortlessly. Generally, though, pain was an accepted part of childbirth and we’d only administer painkillers – intramuscular pethidine – to women who had ceased to cope entirely or who were giving birth to particularly large babies. If there was tearing down below, I’d stitch it up myself, unless it was extensive, in which case I’d call the GP. Back then doctors were very good at midwifery.

Despite all this, it always surprised me how well most women managed in labour. Often it was what they did afterwards that was more of a worry. It’s a myth that everyone is a natural mother. Just because you want a baby doesn’t mean you’ll be any good at dealing with it when it’s born. I met several mothers who were hopeless to the point of neglect. The responsibility of motherhood just wasn’t for them; they got frightened. Later on, when I was a health visitor, I gave evidence in the juvenile court on three occasions about mothers accused of abusing or neglecting their children.

But you couldn’t really blame these women for getting pregnant. Birth control wasn’t as widely available – or morally accepted – back then. I often helped mothers to have their eighth, ninth or 10th child. These women were dab hands at giving birth. Their mothers would be in the kitchen making tea and minding the other children while their husbands assisted them in labour. Yes, you read that right. Many of the fathers I came across would have made excellent nurses.

This wasn’t always the case, though. I’ll never forget the first time a father stepped in to help me. Just as his child’s head started to appear, he fainted across his wife’s body. I didn’t know what to do – he was too heavy to move – but the mother found it so funny that she ended up laughing the baby out. “I knew he’d do that,” she kept saying. It was instances like this that made home births so much more fun than having a child in a hospital. . . .

And thankfully I didn’t witness too many tragedies. Women experiencing complications would go straight to hospital. But I did deliver a couple of premature babies who didn’t make it – in those days you could wave goodbye to any child weighing under 5lb.

During births I was supposed to be supervised by a senior midwife but she was always late. I got used to her turning up in time for a cup of tea after the baby was born and I’d finished cleaning up the bedroom but it didn’t bother me; she’d seen it all before, whereas I was just learning. When I told her about the fainting incident she gave me a look of unadulterated scorn. “Typical man,” she said. “A bloody good period would see them off. Men simply don’t do pain.”


Read the rest here
.
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